Save Our Hospitals is a resident-led campaign group formed in July 2012. We are FIGHTING against the NHS plans to DEMOLISH Charing Cross Hospital and downgrading of our A&Es( Hammersmith, Charing Cross, Ealing and Central Middlesex Hospitals)

Saturday, 31 January 2015

The crisis in the NHS has dominated national news since New Year, but the crisis in west London is into its third year – since the announcement in 2012 that four A&Es and two major hospitals would be closed or downgraded.

Although I'm pleased that the country is waking up to the Coalition Government’s cuts and privatisation agenda, I don’t want to lose track of the battle we have to win to save Charing Cross from the wrecking ball.

A&E waiting times here are among the worst in the country. One in four people is waiting more than four hours. Before Christmas that rose to one in three at Charing Cross.

The spike started as soon as Hammersmith and Central Middlesex A&Es closed last September.

So the idea that they should press ahead with the demolition of Charing Cross is now demonstrably stupid. But that is exactly what David Cameron and Jeremy Hunt wish to do.

Last week I was able to question the managers at Imperial, the NHS Trust who run Charing Cross, Hammersmith and St Mary’s Hospital, at the council’s health scrutiny meeting. I asked their Deputy Chief Executive if they would reconsider the demolition in the light of the A&E crisis. He refused to answer.

Demolition at Charing Cross would mean not only losing the A&E but 336 of 360 inpatient beds, the world-class stoke unit and all emergency consultant services. Only planned day surgery, a GP-run ‘emergency centre’ and some outpatient treatment services would remain on the site. The rest would be sold off for flats.

I have continued to raise the issue in Parliament at every opportunity. Last week in a full debate on the NHS I highlighted several cases residents have brought to my attention where people with serious injuries have waited at the roadside for up to two hours for an ambulance.

I also raised the case of Mrs Fahy, a 94 year-old constituent who, after being rushed to A&E, was forced to wait six hours in a corridor before being seen at Charing Cross. But after one night she was moved to Hammersmith Hospital because there were no beds available. [LINK]

Because I thought this perfectly illustrated the folly of both closing the A&E and losing 905 of the inpatient beds at Charing Cross I also raised Mrs Fahy’s case at Prime Minister’s Questions. Here is his response.

None of the complaints I receive about the ambulance, A&E or health service generally blame the staff. The nurses I recently met at Charing Cross share exactly the same fears as their patients. The quality of care is excellent and the compassion of staff at all levels is something everyone remarks on.

But we are setting them an impossible task. The resources at present are not able to cope with demand. Further closures are unthinkable.

I still believe the battle to save Charing Cross can be won.

• There is increasing clinical evidence opposing the Government's view. This week the RCN, giving evidence to the Mansfield Inquiry set up by west London Labour councils, said further closures should be suspended.

RCN London has backed calls for the suspension of further hospital closures in the area, until guarantees can be given about investment in out of hospital care.

The RCN says it has become increasingly clear that the promised investment in out of hospital care to make up for local A&E closures has not been delivered on the scale needed to keep patients safe.

This winter the remaining A&E units in the area have experienced some of the longest waiting times in the country.

The impact of the programme for patients is now being reviewed by Michael Mansfield on behalf of Brent, Ealing, Hammersmith & Fulham and Hounslow Councils under the name “The North West London Health Commission”. RCN London invited members working locally to contribute to our response to the review.

Among the problems raised by local nursing staff were:

Increased waits for ambulances outside hospitals and dangerous diversions due to capacity problems

A perceived lack of understanding by patients about the status of the new units. One member said “patients and particularly their carers are frightened and confused about the A&E service closures.”

Pressure on GP services, damaging the ability of practice nurses to carry out preventative health interventions – a clear driver over time of the increase in sick people presenting to A&E who should have been kept well earlier in the system.

An “unsafe and unmanageable” strain on district nursing staff.

Difficulty in transferring patients between services which have been differently arranged, creating delays for living donors and mental health patients

Registered nurses “burnt out, tired and frequently unable to get their time for the study days”, jeopardising continuing learning

RCN London Regional Director Bernell Bussue said: “The RCN will always support service reorganisation which delivers improvements in the quality of patient care. However it is just not clear that patients have seen any benefit from these changes so far.

“The positive case for the Shaping a Healthier Future programme was based on an increase in out of hospital care to enable more patients to be kept well or treated at home to reduce hospital admissions. In practice, little seems to have been done to boost capacity elsewhere in the system to make up for the closures. Proper replacement services, transition arrangements, funding and a workforce plan should have been in place before the existing units were cut.

“Nursing staff working in the area have told us the closures have damaged patient care. The remainder of the Shaping a Healthier Future closures should be suspended until out of hospital capacity is properly expanded.”

Nurses today called for the suspension of a controversial programme of downgrading A&E and maternity units in west London amid concerns that patient care is deteriorating.

The Royal College of Nursing said the changes, which began with the closure of the casualty wards at Hammersmith and Central Middlesex hospitals last September, had caused a “predictable and negative impact for patients”.

It said the GP-led Shaping A Healthier Future programme had been introduced “the wrong way round”, as community services were not ready to deal with people no longer being treated in hospitals.

The RCN said patients at the main A&E departments at Northwick Park and Ealing hospitals had repeatedly endured the longest waits in the country in the run-up to Christmas. Its intervention, in a submission to an inquiry set up by four councils, comes as moves to axe the maternity unit at Ealing were delayed for two months.

GPs there are to seek “further reassurance” that capacity exists at neighbouring labour wards before going ahead with the closure.

RCN London regional director Bernell Bussue said: “In practice, little seems to have been done to boost capacity elsewhere in the system to make up for closures. Proper replacement services, transition arrangements, funding and a workforce plan should have been in place before existing units were cut.

“The remainder of the Shaping A Healthier Future closures should be suspended until out of hospital capacity is properly expanded.”

Concerns raised by RCN members in west London include patients being “frightened and confused” by the replacement of A&E units by urgent care centres.

Requested hospice placements were not always granted, while nurses were “burned out and tired” and unable to get time off for study days. Cuts in the number of district nurses had placed an “unsafe and unmanageable strain” on those who remained.

A spokeswoman for Shaping A Healthier Future said: “We have always said it would take three to five years to implement the out of hospital improvements that our residents deserve.

“We are only in year one and we have already delivered weekend access to GP appointments, new community services to treat people closer to their homes and more joined-up working with social care. Over the next three years we will develop plans to build new hospitals — with A&Es — at [Ealing and Charing Cross] which better serve the needs of local people.”

A health worker and patient on a ward in Addenbrooke’s hospital in Cambridge, one of the hospitals which has refused to sign off the NHS budget deal. Photograph: David Levene for the Guardian

England’s biggest hospitals are refusing to sign off their annual budget deal with the NHS, claiming that the £1.7bn of cuts involved will mean they can no longer guarantee the safe care of patients.

In an unprecedented move, hospitals that provide 75% of all NHS hospital care have vetoed plans drawn up by Monitor, the NHS’s financial regulator, to reduce their income to help the service balance its books. “We have now reached the point where patient care is at risk,” the hospitals said.

NHS Providers, which represents 94% of hospitals, said its members could no longer “achieve the impossible” by absorbing a fifth successive year of cuts to the payments they receive for treating patients under the tariff system.

“After five years of unprecedented price cuts, with NHS providers realising more than £20bn of savings over this parliament, objecting to the tariff for many represents a last resort to have their concerns heard, as they can no longer guarantee safe and effective care unless they are properly and fully paid for the patients they treat,” said Chris Hopson, the chief executive of NHS Providers.

Some patients could end up not being treated at all as a result of the public row over where the NHS’s money went, he warned.

If hospitals were not paid the full amount for the care they provided, he said, they might only provide as much care as they could, based on their budget.

An estimated 80% of England’s 160 acute hospital trusts are either already in the red or at risk of ending the 2014-15 financial year in late March with a deficit.

Hospitals are already facing the loss of another £1.9bn of their £40bn annual income to help fund the Better Care Fund, which starts in April and is meant to keep patients healthier at home to relieve the growing pressure on hospitals.

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NHS England, which distributes the service’s £97bn budget, said giving in to the hospitals’ demands would mean less money for GP services, accident and emergency units, mental health care and ambulance services.

“Since the overall NHS funding totals for 2015-16 are now agreed, any fundamental changes to benefit one set of providers would in practice mean robbing Peter to pay Paul,” a spokeswoman said.

The row leaves the NHS in uncharted waters because there is now no agreement over how much hospitals should be paid for work done from 1 April.

It could force the chancellor, George Osborne, to give the NHS more money for 2015-16 in his budget on 18 March, over and above the extra £2bn a year he promised to provide from April in his autumn statement.

The Monitor deal would reduce hospitals’ income by £1.2bn by applying a 1.9% cut to tariff payments, forcing them to save 3.8% of their entire budget by being more efficient – a target hospitals say is completely unrealistic.

They also object to the regulator’s plans to cut £220m from the amount they receive for providing specialised medical services to patients with rare conditions and to an attempt to save another £290m by giving hospitals only half the real cost of treating some A&E patients.

NHS England said the extra £31bn hospitals had received over the past two years for specialised services should mean they could accommodate the £220m cut.

Although the identity of the hospitals rejecting Monitor’s plans was not disclosed, they are understood to include large teaching hospitals which provide many of the NHS’s most vital services, such as the Kings College Hospital and University College London trusts in the capital, University Hospitals Birmingham and Cambridge University Hospitals, which runs Addenbrooke’s hospital.

Richard Murray, director of policy at the King’s Fund health charity, said of the hospitals’ move: “It signals that the policy of implementing year-on-year reductions in the prices paid to hospitals for their services has reached the end of the line.

Murray, a former senior official with the Department of Health and NHS England, added: “It is not clear what the outcome will be but, with just three months to go before the start of the financial year, it will throw financial planning in the NHS into disarray.”

With growing evidence that holding down NHS staff pay is not sustainable, the row shows that the two main ways the NHS has tried to save money since 2010 “have now been largely exhausted”, Murray said.

Under the rules governing how tariffs are set, Monitor can be forced to rethink its proposals if objections are raised by more than 51% of trusts, measured either by number or their share of all NHS activity.

Monitor will now have to revise its plans, call in an independent arbitrator or ask the Competition and Markets Authority to settle the dispute. In total, 37% of trusts signalled their opposition.

A Monitor spokesman said the regulator and NHS England were “now considering the feedback received from the consultation and possible next steps, in the context of what the legislation permits in the event that an objection threshold is breached”.

One of its options included “engaging with the sector then reconsulting on revised proposals”.

Andy Burnham, the shadow health secretary, said the spat showed that the NHS was deteriorating rapidly under the coalition.

Wednesday, 28 January 2015

The Royal College of Nursing is concerned a lack of focus on out-of-hospital care while A&Es are closing will result in an even worse healthcare crisis

Nurses are concerned patients are not getting the right out-of-hospital care for the NHS to justify closing A&Es in west London

Frontline nurses today (January 27) called for the suspension of the west London hospital reorganisation programme until further guarantees can be given about out-of-hospital care.

The Royal College of Nursing (RCN) is asking Imperial College Healthcare NHS Trust and the government to suspend its Shaping a Healthier Future programme which has seen Hammersmith Hospital’s A&E being closed and more changes are to come.

Members are worried patients are suffering from a lack of investment in out-of-hospital care to make up for the closures as they believe it is currently not at a safe level.

The RCN, which focuses on patient needs, today submitted evidence based on local frontline members’ feedback to a review being held by Michael Mansfield QCon behalf of Hammersmith and Fulham, Brent, Ealing and Hounslow Councils.

Local nurses told getwestlondon there were increased waits for ambulances outside hospitals in the area and dangerous diversions were being made due to capacity problems

They also said patients and carers do not understand the new Urgent Care Units which have replaced A&Es at Hammersmith and Central Middlesex Hospitals. One member said: “Patients and particularly their carers are frightened and confused about the A&E closures.”

Members added that pressure on GP services means practice nurses cannot carry out preventative health interventions meaning people are going to A&E who should have been kept well earlier in the system.

Under the Shaping a Healthier Future programme it was argued fewer A&Es were needed if people could be kept out of hospital by preventative health measure.

As well as patients becoming frustrated nurses themselves said they are ‘burnt out, tired and frequently unable to get their time for the next study days'.

RCN London regional director Bernell Bussue, said: “The RCN will always support service reorganisation which delivers improvements in the quality of patient care. However it is just not clear that patients have seen any benefit from these changes so far.

“The positive case for the Shaping a Healthier Future programme was based on an increase in out of hospital care to enable more patients to be kept well or treated at home to reduce hospital admissions. In practice, little seems to have been done to boost capacity elsewhere in the system to make up for the closures. Proper replacement services, transition arrangements, funding and a workforce plan should have been in place before the existing units were cut.

“Nursing staff working in the area have told us the closures have damaged patient care. The remainder of the Shaping a Healthier Future closures should be suspended until out of hospital capacity is properly expanded.”

The RCN has also cited health secretary Jeremy Hunt as saying Shaping a Healthier Future would give north west London ‘probably the best out-of-hospital care anywhere in the country’ but this winter west London’s remaining A&E units have experienced some of the longest waiting times in the country.

Tuesday, 27 January 2015

The RCN has called for the suspension of plans to close a maternity unit and downgrade two emergency rooms in London until guarantees can be made about out-of-hospital provision.

The college has submitted evidence to a review led by Michael Mansfield QC into the Shaping a healthier future programme of hospital reorganisation.

Health secretary Jeremy Hunt announced the programme in November 2013, with an assurance that it would give north west London ‘probably the best out-of-hospital care anywhere in the country’.

RCN members said the closure of A&E units at Central Middlesex, Hammersmith and Barnet hospitals has damaged patient care and out-of-hospital provision is inadequate. Therefore the proposed downgrade of emergency room services at Ealing and Charing Cross and planned closure of Ealing maternity services should be suspended until there is extra capacity.

RCN London regional director Bernell Bussue said the case for the Shaping a healthier future programme was based on an increase in out-of-hospital care to enable more patients to be kept well or treated at home.

‘In practice, little seem to have been done to boost capacity elsewhere in the system to make up for the closures,’ he said.

‘Proper replacement services, transition arrangements, funding and a workforce plan should have been in place before the existing units were cut.’

“This, coupled with a shortage of hospital beds, leads to patients waiting hours on trolleys.”

Delayed transfers of care, or bed blocking, occur when a patient is clinically ready to leave but stays because there is no care at home or in the community.

Bed blocking

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The crisis comes after £1billion of social care cuts.

The average number of beds blocked hit 4,155 last week, up from 2,852 last year.

Ms Bradley said: “Ensuring all patients are discharged safely and in a timely manner all year round would free up more bed days, save money and, most importantly, get people home sooner – which is where we all want to be.”

But the NHS England figures showed a slight improvement in A&E waiting – 92.4% of patients were seen within four hours last week, the best since November. The target is 95%.

The overall number of A&E attendances was down by more than 12,000 in the last week, which suggests more people are heeding warnings to only visit hospitals in emergencies.

But Dame Barbara Hakin, of NHS England, said that while demands had “eased” the NHS was still facing “huge pressures on its frontline services”.

Ministers warned that the NHS is facing ‘a disaster’ of ever-busier accident and emergency departments and bed-blocking

Some 350 deaths were caused by people not being treated fast enough in overstretched accident and emergency departments, a study says. Photograph: Mike Goldwater /Alamy

Up to 500 patients died last year as a direct result of harm they suffered when hospitals became dangerously overcrowded, Britain’s A&E doctors have warned.

About 350 of the deaths were among patients who had not been diagnosed or given medical treatment quickly enough. Another 150 were not admitted because of bed shortages, even though their condition meant they would usually have been found a place on a ward. The College of Emergency Medicine’s figures have raised concern that growing turmoil in A&E units, and hospitals generally, is doing real harm.

Dr Clifford Mann, the college’s president, said its estimates were based on international studies which show that patients who arrived at emergency departments when hospitals are overcrowded were at greater risk of dying. “It’s sobering that up to 500 patients a year die because too many of our emergency departments are too often overcrowded. It’s a cogent reminder to the people who run the NHS that overcrowded emergency departments are just unacceptable and dangerous,” he said.

A&Es in England were busy about 25% of the time, he added, which meant that 3.5 million patients who turned up at an A&E department each year were at slightly increased risk of death.

Applying the results of studies from Australia and Canada showed that up to 350 A&E patients with a range of serious illnesses, who ended up waiting longer for admission than the supposed NHS maximum of 12 hours, would die, Mann said. Although the exact reason is not clear, delays in diagnosis and vital treatment, such as surgery or antibiotics, are thought to explain most of the deaths.

The remaining 100-150 deaths are among patients who turn up at A&E and would usually be admitted, but are sent home because the hospital has run out of beds. Mann said: “We know that mortality rates for a whole range of conditions are higher when A&E units are overcrowded, compared with when they aren’t. There’s an increase in mortality rates for patients when they are admitted from overcrowded emergency departments. We are talking about a relatively small increased risk, but it’s an absolute risk that we should be concerned about.”

In a November 2013 report on reform of urgent and emergency care services, NHS England accepted that overcrowded A&Es do carry an increased risk. “Crowding in A&E departments is a growing threat to patient safety and can have a significant impact on all patients,” it said.

NHS statistics show that the number of patients waiting between four and 12 hours to be admitted, and the numbers waiting for more than 12 hours, both rose significantly during 2014.

NHS England said: “Unprecedented numbers of patients are accessing services, and staff are dealing with the highest-ever number of 111 and ambulance calls, A&E attendances and emergency admissions.

“Demand is highest in winter as more people suffer from serious illnesses, especially respiratory conditions, and there are as a result more deaths at this time of year. This is why we have worked hard to minimise unnecessary delays in urgent care and prioritise those patients at greatest risk. This has included injecting some £700m into the NHS to help bolster services with an extra 700 doctors, 4,500 nurses and more than 3,000 24-hour GP services, 999, 111, A&E and community and social care services.”

Meanwhile, ministers are being warned that the NHS is facing a “disaster” of ever-increasing bed blocking because social care is “chronically underfunded”. An alliance of local councils, NHS organisations and charities says more beds will be occupied by patients trapped there because the services they need after discharge are falling victim to cuts.

“The health and social care system is chronically underfunded. While this remains the case, care and support for elderly and disabled people will only deteriorate,” they say in a letter in the Observer.